The placement of clips and staples in surgical procedures is well known. For example, U.S. Pat. Nos. 4,616,650 to Green et al. and 4,934,364 to Green disclose clip appliers for placing clips, both absorbable and non-absorbable, on tissues and vessels. The clips are fed successively into the instrument jaws and cammed closed. Instruments for placing a plurality of staples on tissue and optionally cutting therebetween are disclosed in U.S. Pat. Nos. 3,494,533 to Green et al. and 4,520,817 to Green. The staples are supplied in pre-loaded cartridges and are formed through contact with oppositely positioned anvil pockets.
An important consideration in the design and utilization of surgical clip appliers and staplers is the visibility and ease of instrument positioning provided to the surgeon. One approach has been to provide a stapler having a fastener applying assembly that articulates relative to the actuator assembly, as disclosed in U.S. Pat. Nos. 4,566,620 and 4,728,020 to Green et al. It has also been suggested to provide a surgical clip applier with a longitudinally curved sleeve, as disclosed in U.S. Pat. Nos. 4,509,518 and 4,624,254 to McGarry et al., and 4,664,305 to Blake.
Instruments for surgically stapling disunited skin of a patient to effect joining of the skin are also known. These instruments typically form substantially box-shaped staples by bending each staple around an anvil placed against the skin, and may be adapted to permit rotation of the staple forming assembly relative to the handles. See, e.g., U.S. Pat. Nos. 3,643,851 to Green et al. and Re. 28,932 to Noiles et al. Fascia staplers have also been disclosed which form fascia staples having a unique geometry for holding fascia tissue. See, e.g., U.S. Pat. No. 4,127,227 to Green.
More recently, attention has focused on minimally-invasive surgical procedures and instruments for facilitating such procedures. Minimally-invasive procedures are typically performed endoscopically through trocar sleeves or cannulas. Prior to introducing the cannula through the body wall, the surgeon generally, insufflates the body cavity with carbon dioxide, e.g., through a Verres needle or like device. Insufflation creates a free area between internal body organs and the body wall. The surgeon then introduces one or more trocars through the body wall into the insufflated body cavity to create a port of entry for accessory instrumentation. For example, graspers, dissectors, clip appliers, lasers and electrocautery devices are routinely employed endoscopically with the visual assistance of an endoscope and an external television monitor.
Endoscopic cholecystectomy (gall bladder removal) has recently met with tremendous clinical success and acceptance. Another procedure receiving attention for adaptation as a minimally-invasive surgical technique is hernia repair, with attention being primarily directed to all types of inguinal hernias (direct, indirect and fermoral). A hernia involves the protrusion of an inner organ or body part through a defect in the muscle wall by which it is ordinarily contained. Historically, hernia repair has been performed by pulling the muscles together around the defect and suturing the muscles together, closing the hole but creating tension on the sutures. More recently, hernia defects have been repaired by suturing mesh over the defect. This approach patches the defect rather than drawing the spaced muscle walls together and/or ligating the hernia sac.
In order to facilitate surgical procedures, and particularly endoscopic procedures such as hernia repair, instrumentation is needed which provides the surgeon with improved visibility and which facilitates positioning of the instrument at the surgical site. A fastening system to provide optimal securement of a mesh or like device, preferably endoscopically, is also needed. These and other objectives are achieved by the present invention.